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Psychology of Sport and Exercise 14 (2013) 437e446
Contents lists available at SciVerse ScienceDirect
Psychology of Sport and Exercise
journal homepage: www.elsevier.com/locate/psychsport
An adolescent perspective on injury recovery and the return to sport
Leslie Podlog a, *, Ross Wadey b, Andrea Stark a, Marc Lochbaum c, James Hannon a, Maria Newton a
a
University of Utah, USA
University of Roehampton, UK
c
Texas Tech University, USA
b
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 2 June 2012
Received in revised form
12 December 2012
Accepted 16 December 2012
Available online 12 January 2013
Objectives: The purpose of this investigation was to examine adolescent athletes’ injury recovery and
return-to-sport experiences. Given previous research highlighting competence, autonomy, and relatedness concerns among returning athletes (Podlog & Eklund, 2006), we sought to examine the extent to
which basic psychological needs theory (BPNT: Ryan & Deci, 2007) could be used as framework for
interpreting the research findings.
Design: A qualitative design was employed in the present investigation.
Method: Eleven Australian athletes (M age ¼ 15.3) who had incurred a range of severe injuries (e.g.,
anterior cruciate ligament tears, shoulder dislocations) were interviewed on 2e3 occasions (n ¼ 27 interviews) spanning an 11-month period.
Results: Analysis of the data revealed the following four key themes: (a) injury stress, (b) coping strategies, (c) experiences with social support, and (d) recovery outcomes. Injury stress provides insights into
a range of stressors and strain responses reported by the adolescents across the recovery phases, while
the theme on coping highlights the specific strategies used to maintain motivation, reduce uncertainties
associated with the injury experience, and to keep focused on future athletic attainment. The third
theme, experiences with social support, considers the transactions the adolescents held with members of
their social network throughout their recovery. The final theme, recovery outcomes, describes participant perceptions of a successful/unsuccessful recovery and stress-related growth.
Conclusions: Results suggest that competence and relatedness issues highlighted in BPNT may be relevant
in exploring adolescent athletes’ injury experience. Somewhat less evidence for the autonomy dimension
of BPNT was apparent in adolescent comments.
Published by Elsevier Ltd.
Keywords:
Self-determination theory
Rehabilitation
Social support
Coping
Introduction
Injury rehabilitation and a return to sport following injury is
often an arduous challenge for competitive athletes (Podlog,
Lochbaum, & Stevens, 2010). In addition to the physical trauma,
injury may induce a host of deleterious consequences such as
diminished self-esteem, negative mood states, and a lost sense of
social identity (Tracey, 2003). Among other injury hurdles commonly reported are the tedium of repetitious (and often painful)
rehabilitation exercises, feelings of isolation and alienation from
sport peers, and a perceived lack of social support from relevant
others (Charlesworth & Young, 2004; Rees, Smith, & Sparkes,
2003). Performance related concerns such as re-injury anxiety,
* Corresponding author. Department of Exercise and Sport Science, University of
Utah, College of Health, 250 S. 1850 E., HPER North, SLC, UT 84112, USA. Tel.: þ1 801
581 7630.
E-mail address: les.podlog@utah.edu (L. Podlog).
1469-0292/$ e see front matter Published by Elsevier Ltd.
http://dx.doi.org/10.1016/j.psychsport.2012.12.005
uncertainties about performing at pre-injury levels, physical
fitness concerns, and pressures to return to sport are also well
documented, particularly as the return to sport approaches
(Bianco, 2001). While these injury challenges have been highlighted among adult and elite athletes, few investigations have
focused on adolescent injury rehabilitation and return to sport
experiences (Brewer et al., 2003; Udry, Shelbourne, & Gray, 2003).
In reviewing the literature on elite athlete injury challenges,
Podlog, Dimmock, and Miller (2011) argued that competence, autonomy, and relatedness issues underlined many of the concerns
revealed by athletes, coaches, and sport medicine professionals. For
instance, uncertainties regarding the ability to perform to preinjury levels, apprehension regarding the impact of injury on the
execution of sport specific skills, and physical fitness concerns
suggest that competence issues are prominent (e.g., Charlesworth
& Young, 2004; Walker, Thatcher, & Lavallee, 2010). External pressures to meet particular return deadlines and internal contingencies of guilt associated with letting down teammates for not
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L. Podlog et al. / Psychology of Sport and Exercise 14 (2013) 437e446
returning, highlight the salience of autonomy issues (e.g., Bianco,
2001). Finally, a loss of social identity, feelings of isolation from
teammates and coaches, and a lack of social support, suggest that
relatedness concerns are prevalent (e.g., Podlog & Eklund, 2006;
Rees et al., 2003).
One theory explicitly examining issues of competence, autonomy, and relatedness is the basic psychological needs mini-theory
(BPNT) of Ryan and Deci (2007) self-determination theory (SDT).
In the mini-theory, competence is characterized by a sense of
effectiveness or accomplishment in one’s pursuits (Ryan & Deci,
2007). The signature feature of autonomy is an internal locus of
causality and the belief that one’s actions are self-endorsed (Ryan &
Deci, 2007). Finally, relatedness refers to a perception of interconnectedness with others and the belief that one has a secure
relational base. According to BPNT, satisfaction of the needs for
competence, autonomy, and relatedness should positively impact
the well-being, personal development, and self-determined
behavior of an individual in a variety of settings (Ryan & Deci,
2000).
Research across numerous contexts including education, health
care, and occupational settings supports need satisfaction contentions (Ryan & Deci, 2000). Recent quantitative findings in a sport
injury setting also reinforce BPNT assumptions. In particular, Podlog
et al. (2010) found that competence and autonomy need satisfaction was associated with a renewed perspective on sport and
that this relationship was partially mediated by positive affect.
Specifically, perceptions that rehabilitation specialists and coaches
satisfied adult athletes’ need to be competent (e.g., feelings of
proficiency in performing rehabilitation exercises) and autonomous (e.g., the provision of choice and options during injury
rehabilitation sessions) was linked with a renewed sport perspective e that is, a positive return-to-sport outcome including
a greater appreciation of sport, heightened motivation for sport
success, and enhanced mental toughness. Moreover, positive affect
appeared to account for some, but not all of the relationship between competence/autonomy need satisfaction and a renewed
sport perspective. In addition, negative affect, self-esteem, and vitality fully mediated the negative relationship between relatedness
need satisfaction and return concerns. These findings suggest that
satisfaction of athletes’ injury rehabilitation needs may foster
positive rehabilitation outcomes (and offset negative outcomes),
a finding that remains to be replicated in the case of adolescent
athletes.
As indicated, much of the psychology of injury research focuses
on adult and elite level athletes, with relatively little examination of
injured adolescent athletes (Weiss, 2003). Preliminary evidence
suggests that there are important reasons for examining injury experiences across the life-span. In particular, a number of age-related
differences have been found with respect to injury responses and
rehabilitation (Brewer et al., 2003). For example, adolescents have
indicated greater preoperative mood disturbances than adults (Udry
et al., 2003), as well as heightened pain, catastrophizing, and anxiety
in the 24 h post-surgery (Tripp, Stanish, Reardon, Coady, & Sullivan,
2003). Moreover, a strong athletic identity has been associated with
early depressive symptoms following injury among adolescents,
while increased social support was associated with lower initial
depressive symptoms (Manuel et al., 2002). Collectively, these
studies indicate that the sport injury experience may vary as
a function of age. The studies also highlight the fact that adolescents,
in particular, may struggle with the onslaught of injury related demands inherent in the rehabilitation process. As adolescence may be
a tumultuous time period characterized by heightened emotionality,
identity concerns, and self-regulation issues, injury related difficulties are not entirely surprising (Weiss, 2003). Finally, the above
studies suggest the potential relevance of BPNT in examining
adolescents’ injury recovery and return to sport experiences. For
example, the depressive symptoms associated with a strong athletic
identity suggest that competence concerns may be prevalent among
injured adolescents no longer able to engage in self-defining activities. Similarly, heightened adolescent catastrophizing and anxiety
indicates that the uncertainties associated with the post-operative
aftermath, may leave adolescents with a perceived lack of control
over their athletic future, a characteristic of low autonomy perceptions. Finally, the enabling influence of social support highlights the
relevance of relatedness issues articulated in BPNT.
In order to better understand the source and nature of adolescent injury related difficulties and experiences, a deeper appreciation of adolescent perspectives is needed. Acquiring such
perspectives would enable a greater theoretical understanding of
the factors influencing adolescents’ injury rehabilitation and return
to sport, and in the development of age appropriate interventions.
From a BPNT standpoint, the extent to which adolescents experience satisfaction of their basic psychological needs may have direct
implications for their rehabilitation motivation, their psychological
health and well-being, and the quality and nature of their returnto-sport experiences. Given preliminary evidence for the benefits
of need satisfaction among injured adult athletes (Podlog et al.,
2010), examining the extent to which injured adolescents experience concerns over (and satisfaction of) competence, autonomy
and relatedness needs is essential for optimizing rehabilitation
environments, and promoting enhanced adolescent well-being.
This knowledge would be useful for parents, coaches, and rehabilitation specialists attempting to better understand and facilitate
the rehabilitation of injured adolescents. Unfortunately, with the
exception of the aforementioned studies, researchers have yet to
heed the call for further developmental inquiry on the psychological aspects of sport injury (Brewer, 2002; Weiss, 2003).
The purpose of this study therefore was to explore adolescent
athlete perspectives of their rehabilitation and return to sport experiences. Given previous research highlighting competence, autonomy, and relatedness concerns among returning athletes
(Podlog & Eklund, 2006), we sought to examine the extent to which
basic psychological needs theory could be used as framework for
interpreting the research findings. In order to meet the study objectives, a qualitative approach was utilized. Qualitative methodologists such as Denzin and Lincoln (2011) and Patton (2002) have
suggested the value of qualitative approaches in examining the
relevance of theoretical issues in particular contexts, in understanding and expanding a priori theoretical knowledge, and in
theory testing. Adolescent athletes were interviewed on two or
three separate occasions during their rehabilitation and return to
sport. Repeated interviews enabled a greater repetition of themes
to emerge across interviews. Multiple interviews facilitated participant reflection of their injury recovery and return to sport experiences close to the actual occurrence of such events.
Methods
Participants
A purposive sample of elite level adolescent athletes was
selected based on several eligibility criteria including: 1) sport
involvement as determined by membership on a regional sport
academy squad, or a state/national team), 2) a current musculoskeletal injury requiring a minimum 1-month absence from sport
participation, 3) undergoing physiotherapy treatment for the injury
at the time of study involvement, and 4) the intent to return to
a similar level of pre-injury participation or higher. Participant
recruitment took place until it was apparent that saturation of key
themes, within the aims of this study, had been reached. This
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L. Podlog et al. / Psychology of Sport and Exercise 14 (2013) 437e446
process resulted in the recruitment of eleven participants (8 females, 3 males) aged 12e17 (M ¼ 15.3, SD ¼ 1.55). Participants were
from regional towns in the Central West region of New South Wales
(NSW), Australia who gave consent for participation in one-on-one
interviews lasting one to two hours. The sports in which the adolescents competed were: basketball (n ¼ 1), netball (n ¼ 5), soccer
(n ¼ 3), rowing (n ¼ 1), and track and field (n ¼ 1). Adolescents’
injury types included: torn anterior cruciate ligament (ACL, n ¼ 1),
shoulder dislocation (n ¼ 2), dislocated knee (n ¼ 2), broken bone
(n ¼ 1 fibula, n ¼ 1 arm), lumbar spine fracture (n ¼ 1), Sherman’s
Disease (n ¼ 1 back), injured Achilles (n ¼ 1), and a bulging disc
(n ¼ 1). All participants competed at the top state level (i.e., state
sport academies and NSW regional institute teams) and had
experienced a range of severe injuries requiring a minimum 1month absence from sport participation. The average absence
from sport participation was 5.41 months (range 1e13 months,
SD ¼ 3.58). Table 1 provides demographic details on each participant. To ensure adolescents’ anonymity, pseudonyms were
utilized.
Interview guide
An interview guide was developed by the first author based on
the psychology of sport injury research, previous experience
developing injury interview guides, and personal experience in
recovering from numerous severe sport injuries. The interview
guide was designed to address rehabilitation phase (e.g., “Describe
any stressors you have experienced during your injury rehabilitation”), pre-return to competition (e.g., “Discuss any forms of
support/assistance that you have received as you prepare to return
to competition?”), and return to competition phase issues (e.g., “To
what extent do you feel you have been successful in your comeback
to date? Explain why or why not?”). When necessary, probe
questions such as what do you mean by.? or “Why was that
stressful when.?” were used for clarification and to explore specific issues in greater detail (see Table 2 for further follow up
questions). For the purposes of this investigation, the rehabilitation
phase was defined as the time from injury occurrence until athletes
were given medical clearance to resume sport specific training. The
pre-return to competition phase reflected the time period following medical clearance when athletes had resumed sport specific
training, but had yet to return to competition. The return-tocompetition period referred to the time period following athletes’
return to sport and included the first 3 months following their
return to competition. The first 3 months was selected for examination given previous research highlighting the initial months to be
439
challenging for athletes (Bianco, 2001; Podlog & Eklund, 2006). The
actual amount of time a participant spent in each phase depended
upon factors such as injury severity and rehabilitation progress. It is
important to note that while three distinct phases were examined
in this research, such phases are in reality, more continuous than
discrete in nature. A full list of interview questions spanning the
different phases is included in Table 2.
Procedures
After receiving institutional research approval, adolescents were
contacted through administrators at the Western Region Academy
of Sport. An information sheet was given to each participant
explaining the purpose of the study and questions of interest pertaining to the study were addressed. During the initial meeting,
informed consent and assent procedures were conducted with the
athlete and his/her parent. All the participants who were contacted
agreed to participate and were interviewed in a quiet room at the
first author’s University or via telephone when necessary. Eight
athletes were interviewed in person while four were interviewed
by phone. Different data collection procedures may have had
a number of consequences with regard to interviewer/participant
rapport and the type or depth of information participants felt
comfortable in revealing. The consequences of different data collection procedures may have influenced the results presented
below, in ways the researchers can only speculate upon. A total 27
semi-structured interviews were conducted over an 11-month
period spanning athletes’ initial injury rehabilitation to 3 months
following the return from injury. Interviews were completed oneon-one in person or when pragmatic concerns such as adolescent/parent availability or researcher travel necessitated, via the
telephone.
Data analysis
All interviews were recorded and transcribed verbatim. The first
stage of analysis involved intratextual (i.e., within-text) and intertextual (i.e., cross case) analysis of the data using the constant
comparative method of analysis (Maykut & Morehouse, 1994).
Intratextual analysis entailed writing analytic memos in the margins regarding salient adolescent injury experiences and grouping
meaningful text segments (i.e., quotes) into raw data themes. Thus,
an adolescent’s comments that explicitly or implicitly related to
physical pain were grouped into the raw data theme “physical
pain”. For example, the comments of one adolescent who stated “So
I went to the Nationals, and I came fourth there [in long jump], but I
Table 1
Participant demographic.
Athlete
Female
athletes
Candice
Linda
Allegra
Amy
Valerie
Heather
Wanda
Gabrielle
Male
athletes
Patrick
Brad
Richard
Age
Sport
Level of
competition
Injury
Injury type
Time away
from training
First serious
injury
16
14
12
16
17
14
16
17
Netball
Basketball
Netball
Netball
Netball
Rowing
Soccer
Netball
Regional
Regional
Regional
State
National
State
National
Regional
Partial shoulder dislocation
Injured achilles
Dislocated knee
Dislocated shoulder
Bulging disk
Sherman’s disease (back)
Broken fibula
Torn ACL
Acute
Acute
Chronic
Chronic
Chronic
Chronic
Acute
Acute
1 month
1 month
12 months
6 weeks
13 months
6 months
9 months
9 months
Yes
Yes
No
No
No
Yes
Yes
Yes
16
14
16
Track and field
Soccer
Soccer
National
State
State
Lumbar spine fracture
Broken arm
Dislocated knee
Acute
Acute
Chronic
3 months
2 months
2 months
Yes
Yes
No
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L. Podlog et al. / Psychology of Sport and Exercise 14 (2013) 437e446
Table 2
Athlete interview guide.
Rehabilitation phase questions
1) When did you first start playing your sport and why did you get involved?
2) How did your injury occur?
3) Can you describe how your rehabilitation has progressed to this point?
4) What are some (if any) stressors you have experienced during your injury rehabilitation?
5) Describe any specific strategies you have used to cope or deal with the stresses of your injury recovery?
6) Can you describe any rehabilitation goals or goals for your return to sport participation?
7) Tell me about whether your injury has been painful physically or psychologically? How so?
8) Have you received pressure from any one to make a speedy recovery? If so, describe what was said or done?
9) Discuss any forms of support/assistance that you have received from your: a) coach, b) parents, c) teammates or d) physiotherapist in assisting you with your recovery.
Follow up: do you feel you have received adequate support from these individuals? Why or why not?
10) What does it mean for you to be successful in returning to sport after injury? Follow up: how will you determine or know whether you’re successful in coming back?
11) Is there anything about your injury recovery you’d like to discuss that we have not touched on?
Pre-return to competition questions
1. Describe your feelings regarding your upcoming return to competition?
2. Do you have any fears or concerns about returning to sport following your time off from injury? Follow up: if so, can you describe what these are?
3. Describe any specific strategies you have used to cope or deal with the stresses of your injury recovery?
4. Tell me about some of the goals you have in regards to your first season back? i.e. what do you hope to achieve/accomplish once you return to sport from injury?
5. Have you received pressure from any one to return to competition? If so, describe what was said or done?
6. Last time I asked about support or assistance received from others. Perhaps you can tell me again about any forms of support/assistance that you have received from
your: a) coach, b) parents, c) teammates or d) physiotherapist in assisting you with your recovery. Follow up: do you feel you have received adequate support from
these individuals? Why or why not?
7. What are some of the things that you have missed about your sport?
8. Do you think that having suffered a serious injury will be of benefit or of help to you once you return to competition?
9. How do you think you will perform once you begin competing?
10. Last time I asked you what it means for you to be successful in returning to sport after injury? Perhaps you can answer the same question now. Follow up: how will you
determine or know whether you’re successful in coming back?
11. Is there anything about your upcoming return to competition that you’d like to discuss that we have not touched upon?
Return to competition interview questions
1. Describe for me what returning to competition has been like mentally and physically?
2. How do you feel you have performed since returning from injury. Follow up: what do you attribute this to? Do you feel you are performing better or worse than you
were before your injury, and if so why?
3. Have you had any fears or concerns since returning to competition following your lay-off from injury? Follow up: if they say no provide list of things that they haven’t
had: e.g. anxiety before first few comps, etc). If so, can you tell me about them and why you’ve experienced these concerns?
4. Can you describe any setbacks, physical or mental, that you may have had since returning to competition?
5. To what extent have you accomplished what you hoped to achieve/accomplish prior to your return from injury?
6. Do you feel that you have learned anything, either technically, physically or mentally since returning to sport from your injury? Follow up: have there been any
benefits to having had an injury?
7. Describe for me the most/least enjoyable aspect(s) of your return, i.e. what has been the best part and what has been the worst?
8. Do you feel that you’ve been successful in your comeback to date? Why or why not?
9. Have you received pressure from anyone to compete? Follow up: if so, describe what was said or done?
10. Describe for me the kind of feedback or any assistance you’ve had from coaches, teammates and friends and family in regards to your performances? Follow up: have
you received adequate feedback, assistance or support from coaches, teammates, parent, or physiotherapists since returning to competition?
11. Is there anything about your return to competition that you’d like to discuss that we have not touched upon?
knew I could have done better if my pain wasn’t there” and “I think I
went to the physio after and they saw that my pelvis was out, and
they fixed that up so I thought it was all good. But I still had pain
after it.” were grouped into the raw data theme reflecting physical
pain. During intertextual analysis, raw data themes that were
common across interviews were identified to form higher order
themes. For example, statements made by different athletes such as
“Yeah, she [my coach] made sure that I was doing well. When I went
back to training she asked me if I was okay and she helped me strap
my shoulder” and “My coach, when the injury initially happened,
he sort of rang up, you know; ‘What’s happened? How long till
you’ll be playing again?’ I told him, and he said ‘Oh, sorry about that
mate’ and ‘Make sure you’re rehabilitated properly and get back to
play whenever you feel you’re ready’” highlighted the concept of
“experiences with social support” and were therefore grouped into
a higher-order theme reflecting this underlining similarity across
the interviews. Once no new themes surfaced, it was assumed that
saturation, within the aims of this study, had been achieved. Four
higher order themes emerged from the data analysis, which are
reported in the Results section below.
The second stage of analysis involved an examination of the
extent to which emergent themes had an underlying conceptual
overlap with competence, autonomy, and relatedness needs articulated within self-determination theory. Given our a priori purpose
of using BPNT as a framework for interpreting adolescent perceptions of their injury experiences, we did not adopt a pure grounded
theory approach (Glaser & Strauss, 1967). Rather, a hybrid approach
(Patton, 2002; Podlog & Dionigi, 2010) was employed in order to
enable (a) the emergence of key themes from the data and (b) the
use of BPNT to interpret our findings. Given previous research
highlighting competence, autonomy, and relatedness issues among
injured athletes we were aware that these issues might also be
relevant to adolescents. While the theory helped shape our interpretation of the themes, we used a combination of inductive and
deductive procedures to derive themes based on participant
statements and to subsequently interpret those themes based on
the BPNT (Ryan & Deci, 2007) informing the research. This combination of inductive and deductive procedures is consistent with
analytic procedures commonly described by qualitative methodologists (e.g., Creswell, 2007; Denzin & Lincoln, 2011; Patton, 2002).
Multiple interviews, empathetic stance, investigator triangulation
and the use of “devil’s advocate” were used to address the “goodness criteria” (Sparkes, 1998). Conducting multiple interviews with
adolescents provided the opportunity to ensure repetition of
themes. Having the first and third authors read through the transcripts on multiple occasions enabled the development of an
empathetic stance by gaining a thorough understanding of participants’ perspectives and point of view. Empathetic understanding
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L. Podlog et al. / Psychology of Sport and Exercise 14 (2013) 437e446
was further cultivated through ongoing discussions between two of
the investigators regarding salient points emerging from interview
transcripts. Investigator triangulation was addressed by the independent analyses of the data using the constant comparative
method described above by the third author and two sport psychology graduate students. Independent categorization of the
themes was followed up with multiple discussions of the theme
classifications to ensure trustworthiness of the theme classifications. These discussions took place on multiple occasions during
the intra and intertextual data analyses to arrive at a general consensus on emergent themes. Finally, the first author and two
graduate students served as devil’s advocate by questioning, challenging and discussing the appropriateness of the independent
theme classifications. Any disagreements resulted in a review of the
transcripts followed by further discussion, until points of contention were resolved and the key themes agreed upon.
Results
The findings are divided into four higher order themes. The first
theme, Injury Stress, provides insights into a range of stressors and
strain responses reported by the adolescents across the recovery
phases (i.e., rehabilitation, pre-return to competition, and return to
competition). The second theme, Coping Strategies, highlights the
specific skills and strategies used by the adolescents over time to
maintain motivation, to reduce uncertainties associated with the
injury experience, and to keep focused on future athletic attainment. The third theme, Experiences with Social Support, considers
the transactions the adolescents held with members of their social
network throughout their recovery. The final theme, Recovery
Outcomes, describes participant perceptions of a successful/less
than successful recovery and stress-related growth (i.e., positive
changes they experienced as a result of injury).
Injury stress
Interviews with adolescents revealed a range of injury related
stressors and strain responses varying in nature and intensity
depending upon the phase of rehabilitation and the proximity of
the return to sport. One of the most commonly cited responses in
the immediate injury aftermath was the physical pain associated
with injury occurrence. Typical of others, Linda suggested that
having to contend with the physical pain of injury occurrence was
arduous, although in her case the pain appeared to subside fairly
rapidly. She commented, “[The pain] was there for about three days
and then it wasn’t as intense for the next few days and then it
eventually wore away.” For adolescents with severe injuries and/or
prolonged rehabilitation regimens, the pain associated with rehabilitation also proved onerous. Gabrielle stated, “The swelling lasted about a month or a bit more and it was pretty challenging trying
to regain all the muscle back in the leg. I’ve only got it equal to the
other leg now, after about 9 months.”
For others, it was not so much the physical pain of rehabilitation
but the prospect of missing substantial periods of competition and
improvement that was psychologically taxing. As Wanda
commented:
It has been painful just because it’s constant; I’d say more psychological. Because I knew what I’d done, I was really upset, but
not because it was hurting. I knew I was going to miss out on
Nationals and because I knew that I was missing that six month
period of improvement.
As adolescents settled into their rehabilitation program, a range
of other stressful experiences were described. These included being
scared by “twinges” of pain or discomfort felt when performing
441
rehabilitation exercises, concerns that the injury would not heal
properly, and confusion about whether to follow conflicting information from doctors and physiotherapists. Frustration among those
living in remote communities who had long commute times to
receive medical treatment, and the negative impact of injury on
one’s life outside of sport (e.g., social life, or school) were also
highlighted.
During the early stages of rehabilitation another prominent
concern was the impact of injury on one’s physical capabilities.
Gabrielle indicated that “the recovery was a bit frustrating at times
when I couldn’t do things that I knew I used to be able to do”.
Frustration over prolonged rehabilitation regimens also created
a sense of agitation as adolescents were unable to experience the
meaning and fulfillment that sport provided, and from engaging in
everyday physical activities or hobbies such as skate boarding or
non-competitive sport.
During the middle and later stages of rehabilitation the primary
concerns appeared to revolve around falling behind teammates and
competitors in terms of competitive ability and physical fitness
losses. For example, Patrick commented, “If I go to a competition
and they’re [competitors are] so far in front of me, I’ll probably
think negative again, getting back into that way of like thinking
what’s the point?” Concerns of a social nature also emerged during
the middle and later stages of rehabilitation. Some indicated feelings of separation from their teammates and that they “no longer fit
in”, being relegated to the role of team supporter or side-line
viewer. Wanda shared that she still “didn’t feel like I was part of
the team” even when the coaches and managers asked her to help
cheer up her teammates after a loss. She indicated that felt “helpless” watching her team play as there was “no possible chance of
you affecting the game.”
Adolescents also suggested that missing out on important aspects of their sport participation was stressful. In particular, the
inability to experience a sense of “fun” and enjoyment, to bond and
socialize with teammates, and to improve sport skills and achieve
athletic goals was psychologically testing for participants. The
comments of Richard nicely encapsulated the void experienced by
adolescents as a consequence of injury. He suggested that he
missed “.the enjoyment of playing. That’s why I play, because it’s
enjoyable, fun to play. You get a good feeling when you do something in the game, kick a goal or whatever. Just enjoyment of
playing and enjoyment of the team aspect.”
As the return to competition grew imminent, adolescents
reported a range of positive and negative responses. Epitomizing
the ambivalent feelings regarding the upcoming return was the
comment of Wanda: “I’m nervous, because, it’s just like my first big
game for a while, I’m a bit, on edge, don’t know how I’m going to
take it, kind of thing, and I’m also just excited because I’m playing
again.”
As the quote above suggested, a number of positive responses
such as the anticipation of re-initiating one’s sport involvement,
demonstrating sport skills, and attaining personal goals were
expressed. A range of negative strain responses however, were also
elucidated. In particular, re-injury worries, doubts over performing
at pre-injury levels, physical fitness concerns, letting down one’s
teammates or oneself, and the impact of injury on one’s sport skills
were all mentioned. As Brad suggested he was
a little worried because I hadn’t played in so long. Like, I didn’t
want to let the team down or nothing like that. Normally I never
worry about that. But yeah, I just worried then [prior to
returning] because I hadn’t played for so long.
Typically, adolescents were concerned about re-injury because
they wanted to avoid being “out for the rest of the season” or
missing further opportunities to compete and attain higher
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performance levels. In some instances however, in particular those
with multiple injury occurrences, the long-term health consequences of further injury damage was of primary importance. As
Valerie commented, “I just now feel like thinking about is it worth
it? Now is the third time that it’s happened. Like, should I really
push myself further if it’s just going to affect my back which could
affect my future.”
Upon resumption of competitive play, some athletes indicated
feelings of disappointment in their performances, shared regrets
about not working harder in rehabilitation, or reported playing
with less tenacity (e.g., being hesitant in “going for the ball” or not
“playing aggressively”) as a result of re-injury concerns. The majority of adolescents however, reported feeling confident in their
rehabilitation, that they were happy and excited to be competing
and “contributing to the team”, and that worries over re-injury
quickly dissipated after testing the formerly injured limb. Moreover, Patrick and Brad reported that they were not as “fit” as they
wanted to be, but were optimistic that competitive fitness levels
would return with time.
Coping strategies
Despite the plethora of stressors and strain responses experienced by adolescents, relatively few deliberate coping strategies
were described. Of the few strategies reported however, they could
be divided into three categories: (a) problem-focused coping, (b)
emotion-focused coping, and (c) avoidance coping. Consistent with
previous research (Crocker & Graham, 1995, p. 326), problemfocused coping was defined as “.cognitive and behavioral efforts
used to change the problem causing distress” while emotionfocused coping involved strategies used to regulate emotional
arousal and distress (e.g., denial, wishful thinking, venting of
emotions). Avoidance coping was characterized as “the effort to
escape from having to deal with a stressor (Carver, 2007, p.124).” In
terms of avoidance coping, one strategy employed by the adolescents was to “try not to think about it [injury]” by keeping one’s
attention on other enjoyable pursuits. In particular, adolescents
suggested that they simply focused “on having fun”, “hanging out
with friends”, or playing computer games. Adolescents also
devoted greater time and energy into their academic pursuits or
non-sport relationships, a strategy that diverted attention away
from negative injury stressors and strain responses. In contrast,
emotion-focused coping involved engaging in physical exercise to
lower the strain responses they were experiencing. The main types
of physical activity mentioned were cycling, swimming and Pilates,
exercises which were deemed acceptable within the confines of
one’s injury. Finally, the majority of the participants used problemfocused coping to expedite the rate of their recovery, which typically involved transferring their energy into their rehabilitation or
to adapted forms of physical exercise and activity that were
acceptable within the confines of their injury. One adolescent
reported, “All I did was just try to improve it [injury] by doing more
physio exercises and stuff like that.”
The other problem-focused coping strategy reported by the
adolescents was goal-setting; they suggested that goals which they
set in conjunction with coaches and physiotherapists helped
expedite their recovery from injury by maintaining motivation,
reducing uncertainties associated with the injury experience, and
preserving a focus on future athletic attainment. Adolescents
highlighted rehabilitation goals, those for the immediate return to
competition, and more long-term goals. Although the aim of “getting over the injury” and resuming competitive play as soon as
possible was at the forefront of adolescents’ minds, the need to
achieve intermediary rehabilitation goals and progressions was
also commented upon. Amy for instance, shared, “Netball’s one of
the big ones [goals]. It takes a little while to get there, but normally
it’s just to, you know, be able to get this exercise done and be able to
do it properly by the time you go see the physiotherapist again.”
In regard to the return to competition, the aim of simply
re-initiating competitive activity and doing so without pain or reinjury was highlighted by virtually all adolescents. Comments
such as “my goal is to play netball again” or “my goal is to not reinjure myself again” typified this sentiment. The occurrence of
multiple injuries however, meant that in some instances, a return
to competition without further injury was an end goal in and of
itself. Richard stated, “My goal is to play, I suppose, for the rest of
the year without re-injuring and at the grand final when we start to
play again. [The goal] at the moment is just to play as well as I can
for the team I’m playing for now. And if that goes well then may be I
can set new goals.”
Adolescents also discussed a number of general and specific
long-term goals. Such goals included continuing to improve one’s
skills and to regain pre-injury fitness levels, to make certain teams
(e.g., state or national teams), to win a medal at a national championships, or to eventually represent one’s country at international
competitions. The various rehabilitation and sport-specific goals
articulated by adolescents appeared important in helping them
remain focused on attaining functional outcomes, cope with the
uncertainties of the injury experience, and stay committed to the
pursuit of higher levels of future athletic proficiency.
Experiences with social support
In attempting to attain their goals and to alleviate the stressful
aspects of the injury experience, adolescents expressed the
importance of social support from parents, teammates, coaches,
sport medicine specialists, and role models. Although adolescents’
did not elaborate in detail about the types of social support
received, it appeared that emotional support (i.e., comfort and
encouragement from parents and coaches to work though rehabilitation challenges), tangible support (i.e., rides to physiotherapy
sessions from parents or performing rehabilitation exercises
alongside adolescents) or informational support from physiotherapists (i.e., providing knowledge about the injury, demonstrating
rehabilitation exercises) were the main forms of support received.
It was suggested that social support served a variety of functions
including the maintenance of a positive outlook, enhancing motivation to comply with rehabilitation protocols, and facilitating
physical and emotional healing. For instance, Heather reported
“trying harder [in rehabilitation] because encouragement from her
coach was motivating” while Candice indicated that having the
support of her coach allowed her to have a “positive outlook” and
helped her heal both mentally and physically. Additionally, athletes
highlighted the receipt of support from sport medicine practitioners and from peers. Amy indicated “the assistance was from the
physio. He helped me a lot. He showed my mum how to strap my
shoulder. I don’t exactly know what it’s called, but he just worked
on it with different types of technology, sort of thing. That helped
a lot.” With regard to peer support, mixed statements were made
regarding the amount of support received. In responding to
whether she received support from school peers, Candice indicated
“Yeah, not so much because I’m playing at a higher level than most
of them. They don’t really know that much about it.” Conversely,
the comment by Richard captured the sentiment echoed by most
adolescents regarding peer support: “A few of my teammates
obviously ring me up, to see how I’m going, you know..They just
encourage me to get back playing, you know. ‘You’ll be right, you’ll
be playing soon’.”
Although the extent of support varied from one athlete to the
next, the majority of adolescents felt as though they had received
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sufficient support and positive feedback. Amy for instance, shared
that she knew she had enough support “because I never thought at
any moment that I was doing it on my own.” Adolescents also
discussed the benefits of support received from injury role models.
Role models who had experienced similar injuries were described
as instrumental in providing a sense of comfort and reassurance
regarding injury related difficulties, inspiration and motivation to
keep pursuing one’s goals, and confidence that one could also
overcome injury related hurdles and attain personal goals. Typical
of this sentiment was the remark of Amy, who commented that she
was “inspired” by role models who had overcome similar injuries
because it made her feel like “I can do that too.”
Interestingly, several adolescents reported feeling a degree of
pressure from their friends and parents to make an expedited return to sport. Patrick’s friends for instance were “always asking him
to hurry up and get better” and Wanda interpreted her parents’
comment that she “play through the pain” as pressure to return to
sport. Somewhat surprisingly, none of the athletes indicated feeling
pressure to return from their coaches. Wanda described her coach
as having “expectations” but not feeling like she was being pressured. Other athletes, including Patrick, Amy, and Linda, stated that
their coach was the person encouraging them to take time to
recover. Patrick’s coach “[gave] me as much time as possible” while
Linda’s required medical clearance from the doctor and/or physiotherapist before returning.
Recovery outcomes
Perceptions of a successful/less than successful return to sport
As the ultimate goal for adolescents appeared to be a successful
return to sport, they were asked to discuss what the concept meant
to them. Prior to the return to sport, perceptions of success included
being able to “play at my full potential.injury free, one hundred
per cent” or simply “just being there” and being “able to play like
everybody else does.” It was also commonly indicated that the return to sport would be a success if adolescents were able to return
to pre-injury performance levels, to fulfill their role on the team,
and to avoid re-injury. Valerie, an athlete dealing with a particularly
difficult back injury, shared her insights on success: “For me at this
stage it wouldn’t really be about winning or losing, it would just be
to feel no pain when I play; to, I guess, be more happy when I play
and smile.”
Following the return to competition, athletes were asked if they
believed their return had been a success. Most adolescents indicated unequivocal feelings of success in their return, describing
a range of success metrics including: the attainment of particular
goals or higher levels of athletic accomplishment (e.g. making
particular teams, achieving personal bests), the ability to avoid reinjury, and the receipt of positive feedback from coaches and significant others. Also of significance, was the feeling that one was
personally satisfied with his or her post-injury performances and
had played to the best of their ability. As Amy commented, “You
know in yourself that you did the best you could and that’s what
matters.”
While the majority of adolescents reported feelings of satisfaction and a sense of success in their return, some expressed
uncertainty over the issue. For several athletes “not playing as well”
as before the injury, lacking assertiveness on the field of play, difficulties with match fitness, and having a negative mindset following the first performance contributed to a sense of ambivalence
regarding the perceived success of one’s return. Brad for instance
stated “Um [long pause] not real sure actually [if the return has
been a success]. A little bit, but probably not because I haven’t been
playing as well as I was before the injury. I’ve just not been able to
like, I could keep up with the game, but not as much as what I could
443
before.” Similarly, Allegra, commented that she felt successful in
getting back to compete but did not feel her return was a success
given that she experienced another knee dislocation within less
than an hour of her initial netball game.
Stress-related growth
As highlighted previously, injury entailed numerous challenges
and stressors. Importantly, however, the injury experience was not
entirely a negative one or one without benefit. In general, adolescents were able to take a philosophical approach to their injury and
to convey a number of positive changes occurring as a result of the
injury including enhanced mental “strength”, increased motivation
to attain athletic goals, superior sport performances, and the ability
to “push” through challenging life circumstances. In discussing her
goal of winning a medal at the rowing State Championships and
attending the national competition, Heather indicated that her
injury made her “.want it a bit more. Because I’ve had the time off,
I just want to keep trying harder to get it.” The comments of Candice personified some of the other growth-aspects of injury:
I’ve just learned how to be a better player. My performance has
lifted I know a lot and I’ve been told by people I’m playing a lot
better because I’ve been selected in this squad. It’ll [injury will]
probably help me mentally, like, it’ll make me stronger, with me
getting back into it again.
Adolescents also suggested that injury provided a number of
learning opportunities. These included the importance of being
patient in giving injury sufficient time to heal, when it was
necessary to cease sports participation and report injury, injury
prevention measures (e.g., proper taping or strapping techniques),
and the fact that even long-term injuries would heal. The occurrence of multiple knee dislocations helped Richard cultivate “.a
bit more patience. So instead of being ‘Oh, I’ve got to play this next
game’, you get like ‘Oh, it’s only another game, I’ve already missed
a heap’. If I got another injury, you could think ‘No, it’s worth sitting
out just so I don’t re-injure it again’.
Discussion
The purpose of this investigation was to examine adolescent
athlete perspectives of their rehabilitation and return to sport experiences. A further objective was to examine the extent to which
self-determination theory could be used as framework for interpreting the research findings. Analysis of the interview data
revealed several key themes including injury stress, coping strategies, experiences with social support, and recovery outcomes.
Interpretation of these themes revealed that issues of competence
(i.e., proficiency) and relatedness (i.e., connectedness or belonging)
were salient in adolescent comments regarding their injury experiences. Some support, albeit to a lesser extent, was also evident
with regard to autonomy issues and adolescent injury experiences.
Given the focus on these three needs in BPNT, it may be a particularly germane theory in interpreting and understanding adolescent injury rehabilitation and return to sport experiences.
As highlighted below, links between findings from this investigation and the theoretical constructs of BPNT are apparent. That
said, BNPT is by no means the only framework in which to examine
or interpret the themes from this investigation. There are other
possibilities. For example, themes regarding stress and coping
highlight health-related quality of life issues (Valovich McLeod, Bay,
Parsons, Sauers, & Snyder, 2009). Moreover, participant statements
suggesting the simultaneous inclination to approach and avoid
certain aspects of their return to competition (e.g., wanting to
compete again while hoping to avoid re-injury), indicates the
relevance of Elliot’s (Elliot & McGregor, 2001) 2 2 achievement
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goal framework in examining motivational aspects of the return to
competition. While a number of different theories may help to
explain various aspects of the rehabilitation and return to sport
transition, BPNT seems to provide a comprehensive perspective in
examining the experiences of adolescent athletes’ in this study.
With regard to injury stress, many of the concerns reported by
adolescents in the present investigation parallel those reported
previously among adult and/or elite level athletes (Podlog &
Dionigi, 2010; Tracey, 2003; Walker et al., 2010). For instance, difficulty in dealing with the physical pain of injury, concerns that
one’s injury would not fully heal, and frustrations over missing
important competitions were all highlighted. As these concerns
were not explicitly related to BPNT needs, it is apparent that there is
a need to explore other theories (or for theoretical integration) in
examining adolescent injury experiences. Other concerns however,
had a more apparent link with BPNT. In particular, worries about
the impact of injury on one’s physical fitness and capabilities, an
inability to improve sport skills and achieve athletic goals, and
“falling behind” competitors were also reported, findings consistent with past research (Bianco, 2001; Walker et al., 2010).
Additionally, stresses of a social nature were articulated including
feelings of separation from teammates, the perception that one “no
longer fit in” with their team, and missed bonding and socializing
opportunities. Such results highlight the fact that competence and
relatedness issues were of primary concern among adolescents.
Given adolescent preoccupations with demonstrating competence
to others (Weiss, 2003), findings from this investigation suggest
that competence based strategies should be at the forefront of
intervention efforts aimed at mitigating adolescent injury stresses.
Consistent with BPNT theorizing (Ryan & Deci, 2007), implementing functional progressions during rehabilitation, exposing injured
adolescents to optimal rehabilitation challenges, setting selfreferenced goals, and providing positive feedback following progress, may all serve to build adolescent perceptions of competence
during the rehabilitation and return to sport phases. Moreover,
ensuring athletes remain involved in their sport, setting up one-onone meetings with coaches, and providing injured adolescents with
team roles and responsibilities may enhance feelings of relatedness
(Podlog et al., 2011). Further research examining the efficacy of
competence and relatedness based interventions, particularly
during the return to sport phase, warrants additional attention.
A range of apprehensions highlighted during the initial and
middle phases of injury rehabilitation re-emerged as salient during
the return to competition. In support of previous research (Podlog
& Eklund, 2006) adolescents reported mixed thoughts and emotions regarding the return to competition. Feelings of excitement
and anticipation about re-initiating one’s sport involvement,
demonstrating sport skills, attaining personal goals, and bonding
and socializing with teammates were tempered by heightened reinjury anxieties, doubts over performing at pre-injury levels,
physical fitness concerns, and letting down one’s teammates or
oneself. While these findings highlight competence and relatedness based concerns articulated in BPNT, implicit in adolescents’
statements was the desire to simultaneously approach and avoid
a return to sport. Such approach/avoidance tendencies suggest the
value of Elliot’s (Elliot & McGregor, 2001) 2 2 achievement goal
framework in examining motivational issues surrounding adolescents’ return to training and competition. Further research is needed to explore the extent to which the return to competition is
characterized by approach versus avoidance tendencies and
whether task versus performance goals predominate during the
return to competition phase.
A number of previously unreported stresses also emerged and
warrant consideration in future research. Specifically, confusion
about whether to follow conflicting information from doctors and
physiotherapists, frustration among rural based athletes who had
long commutes to receive medical treatment, and the impact
of injury on adolescents’ future health and non-sport commitments
may all be relevant issues confronting injured athletes. Once
again, these stresses are not explicitly related to basic psychological
needs; this suggests that although the theory may provide
a framework for examining many adolescent injury stresses, it does
not capture the breadth of such stresses. With regard to conflicting
information from various medical providers, past research has
highlighted the need for a team approach to injury recovery and for
communication among treatment team members and athletes
(Podlog & Dionigi, 2010). Findings from this investigation further
reinforce the need for open lines of communication among various
sport medicine practitioners in order to ensure consistent information is conveyed to athletes; doing so, will likely reduce potential frustrations among recovering athletes. Such communication
may be all the more relevant among practitioners and athletes
living in rural communities where frequency of contact may be
sporadic or non-existent. Further research examining the most
effective means to ensure the provision of consistent rehabilitation
information to injured adolescents is needed. Communication
based theories may be relevant in exploring this issue.
Consistent with previous research (e.g., Carson & Polman, 2010)
a number of injury coping strategies were reported by adolescents.
Several avoidant coping strategies, previously highlighted as
effective in an injury context were also described in the current
study. In particular, the use of physical activity (within injury limitations), socializing with others, and avoiding thoughts of injury by
devoting one’s attention to academic or non-athletic pursuits were
employed. Athletes appeared to use physical activity as a way to
maintain a certain level of physical competence whereas socializing
with others clearly served a relational need. Thus, fulfilling basic
needs described in BPNT appeared to serve an important coping
function. Although further research examining the effectiveness of
various adolescent coping strategies is needed, it is interesting to
note that relatively few deliberate coping strategies were
employed. This may be a reflection of the developmental level of
adolescents, many of whom may have limited experience in dealing
with difficult life events. The relatively minimal range of coping
strategies employed suggests the value of sport psychology services
for injured adolescents. As adolescents are a group notoriously
underserved by sport psychology practitioners, the implementation of coping strategies may be well advised.
Social support also appeared important in helping athletes cope
with injury related demands, in maintaining motivation to adhere
to rehabilitation protocols, and in facilitating emotional adjustment. An abundance of previous research has highlighted the
benefits of social support among injured athletes (e.g., Bianco,
2001; Rees et al., 2003). In line with previous qualitative reports
(e.g., Bianco, 2001), most adolescents were satisfied with the support they received, support which came from a variety of sources
including coaches, parents, teammates and sport medicine providers. Social support was also received from injury role-models.
The benefits of role models including the provision of emotional
comfort, inspiration and motivation to overcome injury rehabilitation obstacles and setbacks, and confidence that one could still
achieve athletic goals, have been echoed previously (Flint, 2007).
Collectively, the above findings provide further support for the
benefit of social support among injured athletes, support that may
be especially relevant among injured adolescents. The findings also
suggest that ensuring athletes feel connected to and cared for by
others is of prime importance in facilitating adolescent recovery
from injury. From a BPNT standpoint, ensuring relatedness need
satisfaction may be crucial in optimizing the likelihood of beneficial
health and well-being outcomes (Ryan & Deci, 2007). Researchers
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L. Podlog et al. / Psychology of Sport and Exercise 14 (2013) 437e446
have suggested that the provision of various forms of social support
(e.g., listening support, informational support, emotional comfort,
emotional challenge) will help ensure relatedness perceptions and
a greater likelihood of subsequent compliance with rehabilitation
protocols (Podlog et al., 2011). Further research testing the efficacy
of relatedness interventions among injured adolescents is needed.
Although most adolescents indicated the receipt of sufficient
social support, this was not always the case. Adolescents suggested that parents did not always provide the support required,
particularly in instances where parental pressures were exerted to
play through pain and injury. Hellstedt (1990) also found that
parental pressures to compete in sport or to play through pain and
injury represented a source of adolescent stress. Conversely, none
of the adolescents indicated pressures from coaches to return to
sport, a finding contrary to previous research (Charlesworth &
Young, 2004). Adolescents suggested that coaches attempted to
minimize return to sport pressures and to ensure that they did not
rush the return. These findings suggest that adolescents experienced varying degrees of external pressure during their injury
rehabilitation and return to sport. From a BPNT standpoint,
external pressures may suppress perceptions of autonomy need
satisfaction because such pressures conduce toward an external
locus of causality (Ryan & Deci, 2007). Findings from this study
add to the growing body of sport injury research suggesting the
benefit of athlete autonomy and diminished perceptions of pressure in making a return to competition following injury (Podlog &
Eklund, 2006, 2009, 2010; Podlog & Dionigi, 2010). Given the
centrality of autonomy need satisfaction within BPNT, further
investigation examining the effectiveness of autonomy enhancing
strategies at various phases of the injury recovery process (e.g.,
injury onset, rehabilitation, decisions to return to competition)
seems warranted.
Two final themes to emerge from the present study pertained
to adolescent recovery outcomes following injury. In particular,
descriptions of the meaning of a successful return to sport and
perceptions of stress-related growth emerged during participant
interviews. Similar to elite athletes, adolescents suggested
a number of success indicators including a return to pre-injury
levels and attaining particular goals, remaining uninjured, and
a feeling of self-satisfaction with one’s performance (Podlog &
Eklund, 2009). Receiving positive feedback from coaches and significant others regarding one’s performance was also an important
determinant of a successful return to sport. Conversely, “not
playing as well” as before the injury, lacking assertiveness on the
field of play, difficulties with match fitness, and having a negative
mindset following the first performance contributed to a perceived lack of effectiveness or success in one’s return to competition. These findings highlight the fact that perceptions of
success and/or a lack of success were largely based on one’s perceived competence or indications from others that one was achieving desired proficiency levels. As adolescent self-worth and
esteem may be highly contingent on positive evaluations from
others (Weiss, 2003), ensuring positive feedback and graduated
opportunities for successful task accomplishment may be essential
in fostering perceptions of competence and subsequent evaluations of success in the return to sport.
Finally, perceptions of injury related growth were articulated.
These included enhanced mental “strength”, heightened intrinsic
motivation to attain athletic goals, superior sport performances,
and the ability to “push” through challenging life circumstances.
Other forms of growth including learning about the importance of
injury prevention measures were also articulated. These findings
are consistent with previous reports of perceived benefits following
the injury experience (Podlog & Eklund, 2006; Wadey, Evans,
Evans, & Mitchell, 2011). Interpreted in BPNT terms, adolescents’
445
experienced growth following injury as they gained perceived
competence from the experience (e.g., enhanced “mental strength”,
superior sport performances), they cultivated an increased sense of
autonomy (i.e., enhanced intrinsic motivation to pursue their
sport), and they experienced satisfaction of their relatedness needs
(i.e., socializing with non-sport peers). That adolescents’ experienced greater “mental strength” following injury, also suggests that
they may have gained a sense of autonomy to follow their own
rehabilitation path or direction and to make decisions they felt
were appropriate at various stages of their recovery. As indicated,
BPNT research demonstrates that need satisfying experiences are
predictive of beneficial health and well-being outcomes (Ryan &
Deci, 2007). Further research is needed to examine the extent to
which injury related growth occurs as a result of need satisfying
experiences during injury rehabilitation.
Conclusions
To our knowledge, this was the first investigation examining
adolescent perspectives of their injury recovery and return to sport
experiences. Important information regarding the nature of adolescent stresses, coping methods, social support interactions, and
recovery outcomes was obtained. Findings suggest that adolescents’ experienced a range of competence (e.g., concerns about
performing at pre-injury levels), relatedness (e.g., missed bonding
opportunities, feelings of isolation), and to a somewhat lesser
extent, autonomy based stresses (e.g., pressure to return). A number of coping strategies e several of which were avoidant in nature
e were described as beneficial in dealing with injury or diverting
attention away from injury related challenges. That said, the fact
that few deliberate coping strategies were employed suggests the
need for sport psychology services among injured adolescents.
Consistent with previous research (e.g., Bianco, 2001; Rees et al.,
2003), the benefit of social support was also highlighted suggesting the relevance of relatedness need satisfaction. Finally, it was
apparent that notions of competence, autonomy, and relatedness
surfaced with regard to athlete experiences of success (or a perceived lack of success) and perceptions of injury related growth.
Given the relevance of competence, and relatedness needs among
injured adolescents, further research examining the benefits of
basic psychological need satisfaction among injured adolescents is
warranted. As autonomy issues were not overly prevalent in adolescent interviews, further research examining the relevance of
autonomy based challenges would be prudent.
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